POTS (Postural Orthostatic Tachycardia Syndrome) is a condition that affects the body's autonomic nerves, causing a increase in heart rate and discomfort when changing position. While most people with pots have a normal pregnancy and live childbirth, some pots patients may have concerns about their medication during pregnancy, potential worsening of symptoms during pregnancy and the effects of pots on their baby. This guide aims to address these concerns and offer specialist advice.
Happily, most women with pots will have a normal pregnancy and deliver a healthy baby. Some pots patients may experience worsening of symptoms during pregnancy, especially if they have Hyperemesis Gravidarum (extreme and persistent vomiting), high blood pressure and fluid retention. This can affect the health of both the mother and the baby.
Medications
Most pots patients take beta-blockers as a first-line treatment, such as Propranolol and labetalol. These medications are widely used and considered safe in pregnancy and breastfeeding. However, it is important to weigh the risks and benefits of continuing or stopping medication with your medical team before becoming pregnant. There is limited information available on the safety of using fludrocortisone, beta-blockers and midodrine in pregnancy. Midodrine is used to narrow blood vessels to prevent blood reflux into the lungs. Despite low risk, it should only be used if beta-blockers and/or fludrocortisone are unable to control symptoms effectively during pregnancy.
Ivabradine may be used as an alternative to beta-blockers in pots. However, there is little available information on the safety of ivabradine in pregnancy and in animal studies some harmful effects were seen. It is therefore not recommended for use during pregnancy and breastfeeding.
Octreotide and other similar medications have an unclear safety profile in pregnancy. Use during pregnancy appears to be safe but further research is needed to confirm this. Their safety during breastfeeding is currently unknown.
Pyridostigmine is used to treat myasthenia gravis during pregnancy. It is felt to be safe and may be continued in pregnancy and breastfeeding.
Clonidine has been used to treat high blood pressure in pregnancy. The information available on its use in pregnancy and breastfeeding does not indicate any worrying effects to either mother or baby.
Healthy Living
Leading a healthy lifestyle will benefit your baby whether you have pots or not. Take folic acid supplements, as some women need vitamin D supplements. Avoid drinking alcohol or taking recreational drugs, undercooked meat, fish and eggs, unpasteurised milk, soft cheeses, unwashed fruit and vegetables, and don't smoke.
During pregnancy
Most women with pots have a similar course in their pregnancy as women without pots. About 60% of women with pots say their symptoms improve in pregnancy, particularly if they are taking medication to manage symptoms. Up to 15 % say their symptoms stay the same. For some women, the symptoms of pots may worsen during early pregnancy, and this is especially true if you have hyperemesis gravida (extreme and persistent vomiting). Occasionally anti vomiting medication or hospital admission for intravenous fluids is necessary. It is important to see your gp if you experience worsening of your symptoms.
During pregnancy you will be referred to the hospital for your antenatal care and have the routine schedule of care and scans to monitor your baby. You may be referred to the anaesthetist to make a plan for any special considerations you may need during labour or delivery. Consider support or compression tights*.
Giving Birth
POTS doesn't influence the type of delivery, and pots is not a contraindICATION to labour or a vaginal birth. The majority of women in recent studies have a normal delivery. A small number have a cesarean section. Both methods of delivery are safe in pots. Make sure that your obstetrician and anaesthetist know about your pots before your delivery. It may be helpful to print information about pots from pots uk website.
Intravenous fluids may be needed if the labour is prolonged and you are unable to maintain your oral fluid intake. In pots, your heart rate might be naturally faster during pregnancy and delivery, and therefore your team may need to bear this in mind when assessing you to detect complications (some of which rely on heart rate changes to detect them).
After Delivery
Some women see an improvement in pots symptoms after childbirth, possibly due to the increased activity of looking after a child. Only a minority of people with pots find that their symptoms worsen after giving birth. It is important to see yourgp if your symptoms are worsening.
After your baby is born, get out of bed and move around as soon as you can after birth. * Consider using compression stockings * Drink extra fluids when breastfeeding * PACE activities – there is always another day * Plan ahead and accept help from family or friends if it is offered – and don't be afraid to ask.
For further information
Article written for medical professionals published by The Obstetrician & Gynaecologist: Follow link
HMSA – pregnancy
EDS UK – pregnancy, birth, feeding and heds
Read Anita's Pregnancy diary here
*This star sign indicates that there is currently no available medical evidence from research studies and the statement is based on patient experience or expert opinion.
